Functional outcome after traumatic cervical spinal cord injury is superior in adolescents compared to adults

Early Surgery (Within 24 Hours) Benefits Patients Suffering from Acute Thoracolumbar Spinal Cord Injury: A Meta-analysis

STUDY DESIGN

A meta-analysis of early surgery for acute thoracolumbar spinal cord injury.

OBJECTIVE

To evaluate whether early surgery increases the American Spinal Injury Association (ASIA) grade of patients confronted with acute thoracolumbar spinal cord injury.

SUMMARY OF BACKGROUND DATA

The idea that early surgery aids the recovery of spinal cord function in patients confronted with acute thoracolumbar spinal cord injury is controversial.

METHODS

All articles were retrieved from the PubMed, Embase, Web of Science and Scopus databases, which were searched from onset until 1 May 2021. All data are presented as odds ratios (ORs) and mean deviations (MDs) with 95% confidential intervals (CIs).

RESULTS

Ten studies, including 6 prospective studies, 3 retrospective studies, and 1 randomized controlled trial, containing 952 patients, were included in the analysis. The results showed that early surgery significantly reduced the number of patients with ASIA grade A (OR 0.27, 95% CI: 0.13-0.58, P <0.01) and B (OR 0.56, 95% CI: 0.39-0.82, P <0.01) status but greatly increased the number of patients with grade E status (OR 1.44, 95% CI: 1.06-1.96, P <0.01). Generally, the patients receiving early surgery achieved >1 ASIA grade improvement (OR 1.70, 95% CI: 1.31-2.21, P <0.01) or >2 ASIA grade (OR 3.55, 95% CI: 2.20-5.70, P <0.01) improvements. Although early surgery did not reduce the incidence of operative complications (OR 0.72, 95% CI: 0.45-1.16, P <0.01), the duration of hospitalization was greatly shortened (MD-3.48, 95% CI: -0.45 to-2.91, P <0.01).

CONCLUSIONS

The spinal cord function of acute thoracolumbar spinal cord injury patients can benefit from early decompression. This conclusion should be further verified with randomized controlled trials.

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Objective: In spinal cord injury (SCI), heterotopic ossification is a frequent secondary complication, commonly associated with limited range of motion of affected joints, which could lead to secondary disability in activities of daily living. Additionally, heterotopic ossifications might challenge the effect of regeneration-promoting therapies on neurological and functional recovery. This study evaluated the impact of heterotopic ossification on clinical recovery within the first year after SCI.

Methods: The study was conducted as a monocentric longitudinal paired cohort study. Recruitment was based on consecutive sampling in the framework of the European Multicenter about Spinal Cord Injury (EMSCI). Recovery profiles were determined using standardized neurological and functional clinical assessments within the 1st year following SCI. All study participants underwent at least two comprehensive standardized neurological and functional clinical examinations according to the International Standards for Neurological Classification of SCI and the Spinal Cord Independence Measure, respectively. Data regarding the diagnosis and treatment of heterotopic ossification were obtained by reviewing the patient medical records. The most similar “digital twin” from the entire EMSCI database were matched in terms of age, acute neurological and functional status to each individual with SCI, and heterotopic ossification.

Results: Out of 25 participants diagnosed with heterotopic ossification, 13 individuals were enrolled and matched to control individuals. Most individuals presented with motor complete injury (75%). Ossifications were most frequently located at the hip joints (92%) and mainly occurred within the first 3 months after SCI. Individuals with heterotopic ossification achieved around 40% less functional improvement over time compared to their matched counterparts, whereas neurological recovery was not altered in individuals with SCI and heterotopic ossification.

Conclusion: Heterotopic ossification—a common complication of SCI—unfavorably affects functional recovery, which in the end is most relevant for the best possible degree of independence in activities of daily living. Upon presentation with heterotopic ossification, neurological improvement achieved through potential restorative therapies might not translate into clinically meaningful functional improvement. Diagnostic algorithms and effective early prevention/treatment options for heterotopic ossification need to be established to ensure the best possible functional outcome.

Clinical Trial Registration: NCT01571531 (https://clinicaltrials.gov).

Pediatric spinal cord injury rehabilitation: A protocol for an international multicenter project (SINpedSCI)

PURPOSE

Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI.

METHODS

A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with ≥20 adolescents aged 13-17 years at least 6 months' post rehabilitation.

RESULTS

Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents' plans for the future.

CONCLUSION

Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.

Early clinical predictors of functional recovery following traumatic spinal cord injury: a population-based study of 143 patients

BACKGROUND

Traumatic spinal cord injuries (TSCI) are associated with uncertainty regarding the prognosis of functional recovery. The aim of the present study was to evaluate the potential of early clinical variables to predict the degree of functional independence assessed by Spinal Cord Independence Measure III (SCIM-III) up to 1 year after injury.

METHODS

Prospectively collected data from 143 SCI patients treated in Western Denmark during 2012-2019 were retrospectively analysed. Data analysis involved univariate methods and multivariable linear regression modelling total SCIM-III scores against age, gender, body mass index (BMI), comorbidity, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades A-B and C-D, ASIA Motor Score (AMS), timing of surgical treatment and occurrence of medical complications. Statistical significance was set at p < .05.

RESULTS

Univariate analyses indicated that variables significantly associated with decreased functional independence included increased age (p = .023), increased BMI (p = .012), pre-existing comorbidity (p = .001), AIS grades A-B (p < .001), decreased AMS (p < .001) and occurrence of medical complications (p < .001). However, in the multivariable regression model were pre-existing comorbidity (p = .010), AIS grades A-B (p < .001), low AMS (p < .001) and late surgical treatment (p = .018) significant predictors of decreased functional independence 1 year after injury.

CONCLUSION

TSCI patients with greatest potential for functional recovery up to 1 year after injury seem to be patients that immediately after trauma present with few or no comorbidities, who sustain motor-incomplete injuries and undergo early decompressive surgery.

[Factors associated with functional improvement in patients with cervical spinal cord injuries]

OBJECTIVE

To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission.

MATERIAL AND METHODS

We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge.

RESULTS

Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge.

CONCLUSIONS

Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.